03D2258467 CLIA NUMBER - VITIELLO PRIMARY CARE, PLLC

Laboratory Demographics

CLIA Number: 03D2258467

Facility Name: VITIELLO PRIMARY CARE, PLLC

Facility Address:
21300 N JOHN WAYNE PKWY STE 108
MARICOPA, AZ
ZIP 85139
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Facility Phone Number: 480 389-9419

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1780325944

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	03D2258467
LAB Type	Practitioner Other
Facility Name	VITIELLO PRIMARY CARE, PLLC
Street	21300 N JOHN WAYNE PKWY STE 108
City	MARICOPA
State	AZ
ZIP	85139
Phone	480 389-9419
CertificateType	4
CertificateEffectiveDate	4/21/2024
CertificateExpirationDate	4/20/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024